Disease burden of congenital cytomegalovirus infection at school entry age: study design, participation rate and birth prevalence

Abstract

Congenital cytomegalovirus infection (cCMV) may lead to symptoms at birth and long-term consequences. We present a nationwide, retrospective cohort study on the outcome of cCMV up to age 6 years. For this study we identified cCMV, using polymerase chain reaction, by analysing dried blood spots, which are taken shortly after birth for neonatal screening. The group of children with cCMV were compared to a group of children who were cCMV negative at birth. Data were collected about their health and development up to age 6 years. Parents of 73 693 children were invited to participate, and 32 486 (44·1%) gave informed consent for testing of their child's dried blood spot for CMV. Of the 31 484 dried blood spots tested, 156 (0·5%) were positive for cCMV. Of these, four (2·6%) children had been diagnosed with cCMV prior to this study. This unique retrospective nationwide study permits the estimation of long-term sequelae of cCMV up to the age of 6 years. The birth prevalence of cCMV in this study was 0·5%, which is in line with prior estimates. Most (97·4%) children with cCMV had not been diagnosed earlier, indicating under-diagnosis of cCMV.

Keywords: Cytomegalovirus; epidemiology; paediatrics.

Fig. 1.

Design of the CROCUS study. cCMV, Congenital cytomegalovirus; CHC, child health centre; PHC, preventive health check; DBS, dried blood spot; NHS, neonatal hearing screening; wk, week; m, month; yr, year.

Fig. 2.

Flowchart of the CROCUS study. ^a Inclusion of matched controls ceased when informed consent was obtained for two matched controls. DBS, Dried blood spot; CMV, cytomegalovirus; cCMV, congenital CMV infection; n indicates number of children.